MEDICARE: DR. SUSAN DARNELL HOMESLEY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OP6693T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720068984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN DARNELL HOMESLEY OD

Provider Business Mailing Address
First Line	:	1516 MAIN ST
Second Line	:	SUITE 102
City	:	RAMONA
State	:	CA
Zip	:	92065-5242
Country	:	US
Telephone Number	:	760-789-0950
Fax Number	:	760-789-6057

Provider Business Practice Location Address
First Line	:	1516 MAIN ST
Second Line	:	SUITE 102
City	:	RAMONA
State	:	CA
Zip	:	92065-5242
Country	:	US
Telephone Number	:	760-789-0950
Fax Number	:	760-789-6057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	08/27/2010

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